Bilateral mechanical thrombectomy for internal carotid artery occlusion and contralateral middle cerebral artery occlusion during transvenous thrombolysis: Case report

Abstract

Objective: Bilateral acute intracranial large vessel occlusion is extremely rare and associated with poor prognosis. We report a case with acute ischemic stroke due to bilateral acute MCA occlusion treated with mechanical thrombectomy. Case Presentation: A 87-year-old male was admitted with unconsciousness (Glasgow Coma Scale 11) and severe left hemiparesis. The NIHSS score was 29. CT showed no early ischemic signs, and intravenous thrombolysis was performed. MRI DWI showed right cerebral infarction, and MRA showed right ICA and right MCA occlusion. Left ICA and MCA were patent. Several minutes after finishing thrombolysis, the condition was deteriorated to coma, tetraparesis and respiratory insufficiency. Emergent endovascular intervention was performed. The initial left carotid angiogram revealed bilateral MCA occlusion. First, mechanical thrombectomy for the left MCA M1 segment occlusion was performed using the combined technique with a stent retriever and an aspiration catheter and leaded to complete recanalization (thrombolysis in cerebral infarction: TICI 3). Right hemiparesis and respiratory insufficiency were improved. Then, the system was transferred to the right ICA, and right carotid angiogram revealed right intracranial ICA and right MCA M1 segment occlusion, which were completely recanalized using the same technique (TICI 3). Although postoperative course was not eventful, his general condition was poor due to heart failure and severe pleural effusion. He was transferred to another hospital with an mRS score of 5. Conclusion: Emergent mechanical thrombectomy is a potentially effective treatment option for acute bilateral MCA occlusion.